Alternate Name(s):
Pancreatic polypeptide
Classification:
Hyperglycemic agent
Original Date:
August 2005
Revised Date:
February 2023
Indications:
- Counteracts severe hypoglycemic reactions in diabetic patients; only useful if liver glycogen stores are normal
- Adjunct in the treatment of refractory heart failure
- Anaphylaxis in the emergency department
Reconstitution and Stability:
- Reconstitute with diluent provided for a 1 mg/mL solution
- For continuous IV infusions further dilute with D5W or D10W. This solution is stable 24 hours at room temperature
Compatibility:
- Solutions Compatible: D5W, D10W
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: no information
- Incompatible: NS, DO NOT mix with any other drugs
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES |
| IM | YES |
| IV Direct | YES Usual dilution: 1 mg/mL Infusion time: 1 minute |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | YES Usual dilution: 0.04 mg/mL |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- <20 kg: 0.02-0.03 mg/kg/dose SC/IM/IV (Maximum: 1 mg/dose)
- >20 kg: 0.5 - 1 mg SC/IM/IV
- May repeat in 20 minutes
- Continuous IV Infusion:
- 0.2 mcg/kg/hr (usual maximum: 1 mg/day)
- Dose is titrated to maintain blood glucose at a level determined by the physician (usually 3-4 mmol/L)
- Indicated for endogenous hyperinsulinism or resistant hypoglycemia
- Anaphylaxis in the emergency department
- 20 - 30 mcg/kg/dose, MAX 1 mg IV over 5 min x 1 dose followed by
IV infusion of 5 - 15 mcg/min - titrated to clinical effect
(consider use in patients who remain hypotensive despite multiple doses of epinephrine, patients on beta blockers, pregnant adolescents and in patients with sodium metabisulfite allergy
Adolescent/Adult:
- 0.5-1 mg SC/IM/IV
- May repeat in 20 minutes
Potential hazards of parenteral administration:
- Hypotension - especially with large doses
- Hypersensitivity reactions (rash, urticaria, rarely hypotension or anaphylaxis)
- Hyperglycemia due to excessive dosage
- Hypokalemia
- Nausea and vomiting
Notes:
- Monitor BP and blood glucose
- 1 unit of glucagon = 1 mg glucagon
- Patient should respond in 10-20 minutes
- Do not delay initiation of glucose infusion while awaiting the effects of glucagon
- Upon responding from coma, the patient should be given oral carbohydrates
- Discontinue infusions gradually to avoid rebound hypoglycemia
- Bolus glucagon in idiopathic hyperinsulinism produces rebound hyperglycemia